Numerous endoscopes are now being used to examine and operate upon various parts of a patient. An endoscope called the Resectoscope has made a most distressing operation called Open Prostatectomy into the finest of all surgeries because it is painless and minimises blood loss. The above statement is qualified `when done well` because complications can occur and make this into the worst of all surgeries.
The diseased prostate obstructs the patients urinary passage just as it leaves the urinary bladder. In this surgery called `Trans Urethral Resection of the Prostate` the prostate is cut into pieces under vision and removed through the said resectoscope.
The prostate gland lies within three boundries namely the bladder neck above, the verumontanum below, and its outer boundery being its capsule. Resecting (cutting) within these limits is safe but if any cutting is done beyond these limits then dangerous complications can occur. Such complications occur when a trainee surgeon operates or if a large prostate is removed by a less experienced surgeon. Reasons for this are that only the operating surgeon can see through the endoscope and recognizing the safe limits becomes difficult especially when the field of vision is obscured by heavy bleeding.
Displaying the prostate on the computer screen and continuous display of the cutting element of its every move will enable the senior surgeon to know exactly what the trainee is doing.
Another important thing is that the gland needs to be removed completely. Any remaining tissue can grow and cause obstruction later. In this invention as soon as the prostatic capsule is reached this is marked and displayed on the computer screen in color. In the end one look at the screen will show the surgeon if any tissue has been left behind.
Serious complications occur if one perforates the prostatic capsule. Many blood vessels are present here and when cut into causes much bleeding and possible shock from blood loss. Also if a large vein is cut then the irrigating fluid enters the blood circulation through the cut vein causing hyponatremia (dilution hence reduction of sodium content of blood). The patient then looses consciousness and goes into shock.
The commonest way this happens is as follows: The surgeon cuts away the prostate from bladder neck to a distance of say 2 centimeters and reaches prostatic capsule here. Then when he begins cutting from this point beyond for another 2 centimeters inadvertantly he cuts an area where capsule has already been reached. The present invention will prevent this by an alarm.
One of the most distressing complications occur when resection is done beyond the verumontanum. The result is damage to the external urethral sphincter causing incontinence. Inability to control urine keeps him continuously wet. The present invention alerts the physician and this complication can now be avoided.
The computer starts timing the surgery and displays the time. When a capsule perforation occurs by mistake this event can be marked and the time interval between this occurrence and the end of surgery is important because the longer this `perforation time` the greater the amount of irrigation fluid can leak outside the prostate and into the blood stream. This time is recorded.
It is possible to record an operation using a video camera but using this is cumbersome because of size and it is expensive. We will now be able to record events occuring during the said procedure in a cheap computer disc and display it whenever desired. Such reliable documentation of what the physician did will become important in the future.